I have written a book on the politics of autism policy. Building on this research, this blog offers insights, analysis, and facts about recent events. If you have advice, tips, or comments, please get in touch with me at jpitney@cmc.edu

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Sunday, May 3, 2015

Mandates in the Carolinas

Hundreds of autistic children in South Carolina would qualify for treatment through their health insurance under a bill that passed the Senate on Thursday, but one lawmaker worries that the state may end up footing the bill while tying itself to the Affordable Care Act.

The measure would ensure that those who have health insurance through a small business and those who buy individual health insurance policies can get autism treatment under a 2007 law known as Ryan’s Law.

That law requires the State Employee Health Plan and other types of insurance to cover autism treatment.

The bill was opposed by Sen. Larry Grooms, R-Berkeley, who said he supports expanded coverage for autism treatment, but wants to ensure that South Carolina isn’t saddled with extra costs under the Affordable Care Act, also known as Obamacare.

The federal health care law would make South Carolina responsible for the cost of expanded autism coverage because Ryan’s Law is a state-level mandate, not a federal requirement. However, in other states where similar laws have been passed, insurance companies have paid the extra costs.

Still, the measure could cost South Carolina between $500,000 and about $2 million to cover autism services for this new group of children.

The state Senate approved Tuesday a bill to ensure that health insurance plans regulated by the state cover diagnosis and treatment for autism.

The 47-1 vote in favor of the bill sponsored by Sens. Tom Apodaca, R-Henderson, and Joyce Krawiecz, R-Forsyth, may represent a turning point in a lengthy effort to improve autism coverage in the state, although one autism advocacy group now wants the state House to make changes to the compromise bill.

The bill approved Tuesday represents a compromise among advocates, insurers and health care providers. It says plans must cover autism spectrum disorder and include coverage of an intensive therapy called adaptive behavior treatment.

However, it allows insurers to cap the amount they pay for adaptive behavior treatment at $40,000 a year and limit its payments for the treatment to those 18 and younger.